Posterior reversible encephalopathy syndrome with transient cortical blindness

Case contributed by Dr Mohamed Saber

Presentation

Acute loss of vision.

Patient Data

Age: 25 years
Gender: Male

The CT study shows bilateral posterior parietal subcortical patchy hypodensities.

The MR study shows bilateral occipital, posterior parietal, and posterior centra semiovale cortical and subcortical patchy and multifocal signal alterations elicit high signal in T2 and flair with no evidence of restriction in the diffusion study.

Case Discussion

This patient is quadriplegic related to an old cord injury presented with acute loss of vision. ophthalmological examination was normal. The blood pressure was markedly elevated (200/120 mm Hg) at the time of presentation suspected to be related to urine retention with subsequent autonomic dysreflexia secondary to a known neurogenic bladder. 

CT and MR studies of the brain revealed signs of posterior reversible encephalopathy syndrome that is suggested to be related to acute blindness.

Cortical blindness is a condition in which the eyes are structurally normal and the pupillary reflexes are maintained, however, there is loss of vision secondary to lesions affecting the occipital cortex bilaterally 1.

This patient gradually regained his vision within 24 hours consistent with transient cortical blindness.

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